Items in AFP with MESH term: Evidence-Based Medicine

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Diagnosis and Management of Benign Prostatic Hyperplasia - Article

ABSTRACT: Benign prostatic hyperplasia is a common condition affecting older men. Typical presenting symptoms include urinary hesitancy, weak stream, nocturia, incontinence, and recurrent urinary tract infections. Acute urinary retention, which requires urgent bladder catheterization, is relatively uncommon. Irreversible renal damage is rare. The initial evaluation should assess the frequency and severity of symptoms and the impact of symptoms on the patient's quality of life. The American Urological Association Symptom Index is a validated instrument for the objective assessment of symptom severity. The initial evaluation should also include a digital rectal examination and urinalysis. Men with hematuria should be evaluated for bladder cancer. A palpable nodule or induration of the prostate requires referral for assessment to rule out prostate cancer. For men with mild symptoms, watchful waiting with annual reassessment is appropriate. Over the past decade, numerous medical and surgical interventions have been shown to be effective in relieving symptoms of benign prostatic hyperplasia. Alpha blockers improve symptoms relatively quickly. Although 5-alpha reductase inhibitors have a slower onset of action, they may decrease prostate size and alter the disease course. Limited evidence shows that the herbal agents saw palmetto extract, rye grass pollen extract, and pygeum relieve symptoms. Transurethral resection of the prostate often provides permanent relief. Newer laser-based surgical techniques have comparable effectiveness to transurethral resection up to two years after surgery with lower perioperative morbidity. Various outpatient surgical techniques are associated with reduced morbidity, but symptom relief may be less durable.


How to Find Answers to Clinical Questions - Article

ABSTRACT: Many barriers exist to finding answers to physicians' clinical questions. Lack of time, resources, and computer skills, as well as physicians' environment and attitudes about problem solving, all contribute to unanswered questions. Making use of computer-based information resources can give physicians a framework for answering questions and keeping their practice consistent with the best available evidence.


Finding High-Quality Review Articles - Article

ABSTRACT: A wide array of resources summarizing medical information are available, and physicians must carefully choose the most trustworthy sources. Treatment decisions should be based on the best available evidence, which should be carefully critiqued for both relevance and validity. Paying particular attention to sources that use the Strength of Recommendation Taxonomy can help guide busy physicians to the most useful information sources.


Predicting Mortality Risk in Patients Undergoing Bariatric Surgery - Point-of-Care Guides


Predicting Rheumatoid Arthritis Risk in Adults with Undifferentiated Arthritis - Point-of-Care Guides


Identifying and Using Good Practice Guidelines - Article

ABSTRACT: Performance measurement and payment are increasingly linked to goals established by practice guidelines. The best guidelines are based on systematic reviews and patient-oriented evidence, use an evidence-rating system such as the Strength of Recommendation Taxonomy, and are prospectively validated. The guidelines also should have a transparent development process, identify potential conflicts of interest, and offer flexibility in various clinical situations.


Subclinical Hypothyroidism - Cochrane for Clinicians


Diagnosis of Appendicitis: Part II. Laboratory and Imaging Tests - Point-of-Care Guides


Quality of Life in Older Persons with Dementia Living in Nursing Homes - FPIN's Clinical Inquiries


Differential Diagnosis of Tremor - FPIN's Clinical Inquiries


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